Prevalence of Prehypertension in Nigeria: a Systemic Review and Meta-analysis

¹Department of Anatomy
Bayero University Kano
*Author of Correspondence, Email: musabashir34@gmail.com, GSM: +2347036878467

ABSTRACT
Prehypertension is a borderline blood pressure status associated with both higher incident cardiovascular disease as well as higher risk of progression to hypertension. There is a rising burden of hypertension and prehyperension globally. This study aims to estimate the burden of prehypertension in Nigeria. Online searches of Google Scholar, PubMed and African Index Medicus were conducted and studies selected based on predefined criteria. 64 studies consisting of 62396 individuals conducted between 2011 and 2021 were included in the meta-analysis. The pooled prevalence of prehypertension in Nigeria was found to be 33%
(95% CI: 30%-36%) translating to 39.6 million adult Nigerians. Males have higher prehypertension prevalence of 37.4% (95% CI: 33%-42%) than females with prevalence of 31.3% (95% CI: 27.2%-35.5%). The regions with the lowest prehypertension prevalence are North-Central and South-East each at 31%. The region with the highest prevalence of prehypertension is North-East at 62%. The pooled prevalence in rural settings is 33% whereas the pooled prevalence for urban settings is 32%. Differences between sexes, regions and between rural and urban settings were not statistically significant. In conclusion, the burden of prehypertension in Nigeria is high and represents a future burden of hypertension and other cardiovascular events

Keywords: Pehypertension, Prevalence, Nigeria

1 INTRODUCTION

Prehypertension (PHTN) is a borderline high-risk blood pressure status. It is defined as systolic Blood Pressure(BP) of 120-139mmHg and/or diastolic BP of 80-89mmHg(National High Blood Pressure Education Program, 2004). Prehypertension is associated with about fourfold increased risk of developing hypertension compared to normotensive individuals with 10% annualized progression rate to hypertension(Vasan et al., 2001). In addition to this high risk of conversion to hypertension, prehypertension is associated with 200% increase in cardiovascular disease incidence compared to blood pressure less than 120/80mmHg(National High Blood Pressure Education Program, 2004).
There is worldwide increase in the burden of high blood pressure. In a pooled analysis of 1479 studies from 174 countries including 19.1 million participants, there were 594 million people with high blood pressure in 1975. This number increased to 1.13 billion people in 2015 with the increase largely in developing countries. 88% of mortality attributable to high BP is now in developing countries (NCD Risk Factor Collaboration (NCD-RisC), 2017).
In a meta-analysis of 242 322 individuals from 11 countries including Nigeria, prevalence of prehypertension was 38% (Guo et al., 2012). In a recent meta-analysis of 9 studies conducted in Nigeria between 1995 to 2020 and consisting of 16, 241 individuals, the prevalence of prehypertension was found to be 30.9% (95% CI: 22.0-39.7). However, the analysis involved studies conducted in only 4 of the 6 geo-political zones of the country. In addition, no sex-specific prevalence of prehypertension was reported. (Adeloye et al., 2021). This study aims to determine the sex-specific prevalence of prehypertension across the 6 geo-political zones as well as in urban and rural settings of Nigeria.

2 METHODOLOGY

2.1 Study Area

Nigeria is a western African nation with an area of 923,769 sq km, home to more than 250 ethnic groups(Udo et al., 2020). It has 36 states and a capital divided into 6 geo-political zones or regions. The estimated population in 2021 is 211.4 million. 43.4% of the population are under the age of 14 years. 53.9% of the population are between the ages of 15 and 64 years. Only 2.8% of the population are above the age of 65 years (UNFPA - United Nations Population Fund, 2021). Figure 2.1 shows the map of the geopolitical zones of the country.

Figure 2.1: Geo-Political Zones in Nigeria

2.2 Inclusion and Exclusion Criteria

Included in this review are studies carried out in Nigeria which:

1. have study subjects > 18 years of age
2. are community-based observational and interventional
3. defined prehypertension as systolic Blood Pressure(BP) of 120-139mmHg and/or diastolic BP of 80-89mmHg.

Excluded from this review are studies

1. conducted in individuals < 18 years
2. conducted in pregnant women
3. that did not report prevalence of prehypertension
   
4. that are hospital-based.

2.3 Studies Search Strategies

Online databases used were Google Scholar, PubMed, Global and African Index Medicus. Search words and phrases used were: ‘prehypertension,’ ‘pre-hypertension’ and ‘hypertension.’Searches were repeated for each word with the name ‘Nigeria.’

2.4 Data Extraction and Analysis

Extracted information from the studies included prevalence of prehypertension, state and region of the study, study year, mean age and sex composition of the study participants. Random Effects Model for pooling prevalences and Mixed Random Effects Model for meta-regression were fitted using inverse variance method with correction of pooled estimate and its variance using Sidik-Jonkman’s estimator for between study heterogeneity. Analyses were done in R statistical environment for statistical computing, version 4.1.0 (R Core Team, 2021)

3 RESULTS

3.1 Search Results

Figure 3.1 shows the results of the search strategy.

Figure 3.1: Results of the Search

3.2 Characteristics of the Included Studies

64 studies consisting of 62396 individuals met the inclusion criteria and are included in the meta-analysis. The studies were conducted between 2011 and 2021. There were 22 studies from the south-west region, 16 studies from the south-south, 11 studies from south-east, 9 studies from the north-central, 5 studies from the north-west and 1 study from the north-east region. 4 studies were conducted in more than 1 region. 18 were conducted in the rural areas, 47 in urban areas. 3 studies were conducted in both rural and urban areas and did not report separate data for the two settings.
The reported mean age of the studies’ subjects ranged from 31in a north-central study conducted in both urban and rural areas to 55.2 in a south-west study also conducted in both urban and rural settings (Figure 3.2

Figure 3.2: Number of Included Studies by Region and Setting

Figure 3.3: Mean Age and Number of Subjects in the Included Studies by Region

3.3 Fitting the Meta Analytic Model

Random Effects Model was fitted using inverse variance method with correction of pooled estimate and its variance using Sidik-Jonkman’s estimator for between study heterogeneity. Prevalences are tranformed using arcsine transformation. Figure 3.4 shows the forest plot of the model.

Figure 3.4: forest plot

The overall pooled prevalence of prehypertension in Nigeria is 33% (95% CI: 30%-36%). According to the latest data by UNFPA - United Nations Population Fund (2021), this translates to estimated 39.6 million adult prehypertensive individuals in Nigeria. The P value for the random meta analytic model is <0.001. The estimated total between studies heterogeneity(tau²) = 0.02(S.E = 0.003). I² = 98.5%. Test for Heterogenity showed Q(df= 67) = 3540, p-value<0.001 indicating substantial heterogeneity between the included studies.

3.4 Diagnostics of the Meta Analytic Model

Figure 3.5 shows radial plot of the model with no obvious outlier. This is confirmed by the influence analysis in figure 3.6.

Figure 3.5: radial plot of the model

Figure 3.6: Influence analysis of the model

3.5 Sex-Specific Prevalences of Prehypertension in Nigeria

As shown in figure 3.7, males have higher prehypertension prevalence of 37.4% (95% CI: 33%-42%) than females with prevalence of 31.3% (95% CI: 27.2%-35.5%). The difference is not statistically significant (P = 0.052)

Figure 3.7: Prevalence of Prehypertension in Males and Females

3.6 Prevalence of Prehypertension in Nigeria by Geo-political Region

Figure 3.8 shows pooled prehypertension prevalences by geo-political zones in Nigeria. The regions with the lowest prehypertension prevalence are North-Central and South-East each at 31%. The region with the highest prevalence of prehypertension is North-East at 62%. The P value of the model is 0.130 indicating lack of statistically significant difference in prevalence of prehypertension across the 6 geo-political regions in the country.

Figure 3.8: Forest Plot and Map of prevalence of Prehypertension by region

3.7 Difference in Prevalence of Prehypertension between Urban and Rural Settings in Nigeria

As figure 3.9 shows The pooled prevalence in rural settings is 33% whereas the pooled prevalence for urban settings is 32% The difference is not statistically significant (P = 0.799)

Figure 3.9: forest plot of prevalence by rural and urban settings

4 DISCUSSION

The pooled estimate of prehypertension prevalence found by this study (33%) is similar to the prevalence of 30.9% found by Adeloye et al. (2021). However, the estimate of this meta-analysis is more precise as evidenced by its 95% Confidence Interval (30%-36%) compared to the Confidence Interval of the estimate by Adeloye et al. (2021) (22.0%-39.7%). The reason for this disparity in precision is explained by the difference in the number of studies and individuals included in the two meta-analyses; our analysis involves larger number of studies and individuals explaining the higher precision of our estimate. It is of note that prehypertension and hypertension have almost the same prevalence (Adeloye et al., 2021). This essentially means that two-thirds of adult Nigerians have abnormal blood pressures and are at high risk of developing endpoint cardiovascular events like stroke, coronory heart disease and chronic kidney disease.
The higher prevalence of prehypertension in males compared to females found in this study is consistent with global trend as found in another meta-analysis of published literature world-wide(Guo et al., 2012).
Figure 4.1 shows the burden of prehypertension in Nigeria compared with prevalences in England, Canada (Joffres et al., 2013), Ghana (Dosoo et al., 2019), India (Tripathy et al., 2017), China (Jin et al., 2013), Iran (Afsargharehbagh et al., 2019) and Nepal (Huang et al., 2019).

Figure 4.1: Prevalence of Prehypertension in Selected Countries

5 SUMMARY AND CONCLUSION

33% (95% CI: 30%-36%) of adult Nigerians or 39.6 million adult Nigerians have prehypertension. Males have higher prehypertension prevalence of 37.4% (95% CI: 33%-42%) than females with prevalence of 31.3% (95% CI: 27.2%-35.5%). The regions with the lowest prehypertension prevalence are North-Central and South-East each at 31%. The region with the highest prevalence of prehypertension is North-East at 62%. The pooled prevalence in rural settings is 33% whereas the pooled prevalence for urban settings is 32%. Differences between sexes, regions and between rural and urban settings were not statistically significant. In conclusion, the burden of prehypertension Nigeria is high and represents a future burden of hypertension and other cardiovascular events

REFERENCES

Abah, I. (2014). Hypertension prevalence, knowledge, attitude & awareness among pharmacists in Jos, Nigeria. West African Journal of Pharmacy, 25, 98–106.

Abu-Saeed, K., Odili, V. U., & Muslim, J. O. (2014). High Prevalence of Hypertension among Residents of Ilorin. 1(1), 54–58. http://www.jsppharm.org/home/abstract.php?id=11&aTitle=High%20Prevalence%20of%20Hypertension%20among%20Residents%20of%20Ilorin

Adamu, H., Makusidi, A. M., Liman, H. M., Isah, M. D., Jega, M. R., & Chijioke, A. (2014). Prevalence of Obesity, Diabetes Type 2 and Hypertension among a Sampled Population from Sokoto Metropolis-Nigeria. Journal of Advances in Medicine and Medical Research, 2065–2080. https://doi.org/10.9734/BJMMR/2014/7540

Adedoyin, R. A., Mbada, C. E., Balogun, M. O., Martins, T., Adebayo, R. A., Akintomide, A., & Akinwusi, P. O. (2008). Prevalence and pattern of hypertension in a semiurban community in Nigeria. European Journal of Cardiovascular Prevention and Rehabilitation, 15(6), 683–687. https://doi.org/10.1097/HJR.0b013e32830edc32

Adejumo, E. N., Ogundahunsi, O. A., Adejumo, O. A., Daniel, O. J., Okafor, P. A., & Azenabor, A. (2013). Generalized And Abdominal Obesity; The Association With Hypertension Among Men In Ikeja, Lagos State. Nigerian Journal of Clinical Medicine, 5(1). https://doi.org/10.4314/njcm.v5i1.5

Adelowo, A., & Mercy, O. (2019a). An Assessment of the Prevalence of Diabetes Mellitus and Its Risk Factors among People Living in Abuja, Nigeria. 5, 171–186.

Adelowo, A., & Mercy, O. (2019b). An Assessment of the Prevalence of Diabetes Mellitus and Its Risk Factors among People Living in Abuja, Nigeria. 5, 171–186.

Adeloye, D., Owolabi, E. O., Ojji, D. B., Auta, A., Dewan, M. T., Olanrewaju, T. O., Ogah, O. S., Omoyele, C., Ezeigwe, N., Mpazanje, R. G., Gadanya, M. A., Agogo, E., Alemu, W., Adebiyi, A. O., & Harhay, M. O. (2021). Prevalence, awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence. Journal of Clinical Hypertension (Greenwich, Conn.), 23(5), 963–977. https://doi.org/10.1111/jch.14220

Adeoye, A. M., Adebiyi, A., Owolabi, M. O., Lackland, D. T., Ogedegbe, G., & Tayo, B. O. (2016). GENDER DISPARITY IN BLOOD PRESSURE LEVELS AMONG NIGERIAN HEALTH WORKERS. Journal of Clinical Hypertension (Greenwich, Conn.), 18(7), 685–689. https://doi.org/10.1111/jch.12735

Afsargharehbagh, R., Rezaie-Keikhaie, K., Rafiemanesh, H., Balouchi, A., Bouya, S., & Dehghan, B. (2019). Hypertension and Pre-Hypertension Among Iranian Adults Population: A Meta-Analysis of Prevalence, Awareness, Treatment, and Control. Current Hypertension Reports, 21(4), 27. https://doi.org/10.1007/s11906-019-0933-z

Ajayi, D. D., Deji, S. A., Odu, O. O., Dada, S. A., Amu, E. O., & Marcus, O. (2019). Cardiovascular Disease Risk Factors Assessment of Women Attending a Religious Program in Ado Ekiti, Nigeria. American Journal of Biomedical and Life Sciences, 7(2), 36. https://doi.org/10.11648/j.ajbls.20190702.12

Ajayi, I., Sowemimo, I., Akpa, O., & Ossai, N. (2016). Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria. Nigerian Journal of Cardiology, 13(1), 67. https://doi.org/10.4103/0189-7969.165168

Akinbodewa, A. A., Adejumo, A. O., Koledoye, O. V., Kolawole, J. O., Akinfaderin, D., Lamidi, A. O., Gbakinro, G. O., Ogunduyile, C., & Osungbemiro, W. B. (2017 Jan-Mar). Community screening for pre-hypertension, traditional risk factors and markers of chronic kidney disease in Ondo State, South-Western Nigeria. The Nigerian Postgraduate Medical Journal, 24(1), 25–30. https://doi.org/10.4103/npmj.npmj_161_16

Akinlua, J. T., Meakin, R., Umar, A. M., & Freemantle, N. (2015). Current Prevalence Pattern of Hypertension in Nigeria: A Systematic Review. PLOS ONE, 10(10), e0140021. https://doi.org/10.1371/journal.pone.0140021

Aladeniyi, I., Adeniyi, O., Owolabi, E., Fawole, O., Adeolu, M., Ter, G., & Ajayi, A. (2017). Prevalence, Awareness and Correlates of Hypertension Among Urban Public Workers in Ondo State, Nigeria. Online Journal of Health and Allied Sciences, 16.

Ale, O., Ajuluchukwu, J., Oke, D., & Mbakwem, A. (2014). Impact of prehypertension on left ventricular mass and QT dispersion in adult black Nigerians. Cardiovascular Journal of Africa, 25(2), 78–82. https://doi.org/10.5830/CVJA-2014-010

Ambakederemo, T. E., & Chikezie, E. U. (2018). Assessment of some traditional cardiovascular risk factors in medical doctors in Southern Nigeria. Vascular Health and Risk Management, 14, 299–309. https://doi.org/10.2147/VHRM.S176361

Andy, J. J., Peters, E. J., Ekrikpo, U. E., Akpan, N. A., Unadike, B. C., & Ekott, J. U. (2012). Prevalence and correlates of hypertension among the Ibibio/Annangs, Efiks and Obolos: A cross sectional community survey in rural South-South Nigeria. Ethnicity & Disease, 22(3), 335–339. https://www.ethndis.org/edonline/index.php/ethndis/article/view/459

Ayanniyi, O., Akinremi, A., Odunnaiya, N., & Adenaike, I. (2016). Cardiovascular disease risk among professionals: A survey of modifiable risk factors among teachers in an urban community. Highland Medical Research Journal, 16(1), 1–6. https://doi.org/10.4314/hmrj.v16i1

Ayodele, O. E., Akanbi, O. O., Akinwusi, P. O., Hassan, A. O., & Ogunro, P. O. (2009). Urinary Abnormalities, Blood Pressure and Anthropometric Profiles Among Students in a Nigerian University. Tropical Journal of Nephrology, 4(1), 21–29. http://www.tjn-online.com/index.php/tjn/article/view/91

Banigbe, B. F., Itanyi, I. U., Ofili, E. O., Ogidi, A. G., Patel, D., & Ezeanolue, E. E. (2020). High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative. PLOS ONE, 15(11), e0242870. https://doi.org/10.1371/journal.pone.0242870

Bello-Ovosi, B. O., Asuke, S., Abdulrahman, S. O., Ibrahim, M. S., Ovosi, J. O., Ogunsina, M. A., & Anumah, F. O. (2018). Prevalence and correlates of hypertension and diabetes mellitus in an urban community in North-Western Nigeria. Pan African Medical Journal, 29(1), 1–7. https://doi.org/10.4314/pamj.v29i1

Booth, J. N., Li, J., Zhang, L., Chen, L., Muntner, P., & Egan, B. (2017). Trends in Prehypertension and Hypertension Risk Factors in US Adults. Hypertension, 70(2), 275–284. https://doi.org/10.1161/HYPERTENSIONAHA.116.09004

Charles-Davies, M. A., Fasanmade, A. A., Olaniyi, J. A., Oyewole, O. E., Owolabi, M. O., Adebusuyi, J. R., Hassan, O., Ajobo, M. T., Ebesunun, M. O., Adigun, K., Akinlade, K. S., Fabian, U. A., Popoola, O. O., Rahamon, S. K., Okunbolade, W., Ogunlakin, M. A., Arinola, O. G., & Agbedana, E. O. (2013). Metabolic Alterations in Different Stages of Hypertension in an Apparently Healthy Nigerian Population. International Journal of Hypertension, 2013, 351357. https://doi.org/10.1155/2013/351357

Dada, I. O., & Igbe, I. A. (2020). Feeding habits, Overweight, Obesity and Hypertension and Associated Factors among Polytechnic Students in Ekiti State, Southwest Nigeria. Journal of Multidisciplinary Research in Healthcare, 7(1), 33–48. https://doi.org/10.15415/jmrh.2020.71003

Dokunmu, T. M., Yakubu, O. F., Adebayo, A. H., Olasehinde, G. I., & Chinedu, S. N. (2018). Cardiovascular Risk Factors in a Suburban Community in Nigeria. International Journal of Hypertension, 2018, e6898527. https://doi.org/10.1155/2018/6898527

Dosoo, D. K., Nyame, S., Enuameh, Y., Ayetey, H., Danwonno, H., Twumasi, M., Tabiri, C., Gyaase, S., Lip, G. Y. H., Owusu-Agyei, S., & Asante, K. P. (2019). Prevalence of Hypertension in the Middle Belt of Ghana: A Community-Based Screening Study. International Journal of Hypertension, 2019, e1089578. https://doi.org/10.1155/2019/1089578

Egbi, O. G., Rotifa, S., & Jumbo, J. (2015). Prevalence of hypertension and its correlates among employees of a tertiary hospital in Yenagoa, Nigeria. Annals of African Medicine, 14(1), 8. https://doi.org/10.4103/1596-3519.148709

Egbi, O., Ogoina, D., & Oyeyemi, A. (2018). Prevalence of hypertension and associated factors in a rural community in Bayelsa State. International Journal of Research in Medical Sciences, 6, 1106. https://doi.org/10.18203/2320-6012.ijrms20181264

Egbuonu, A. C. C., Egbuonu, O. N. C., Akabogu, N., Udensi, Z. I., Ugwo, U. O., & Ejidike, A. G. (2015). The Prevalence And Demographic Pattern Of Obesity And Its Correlates In Undergraduates Of Michael Okpara University Of Agriculture Umudike South-East, Nigeria. https://doi.org/10.5281/ZENODO.217047

Ejike, C. E. C. C., & Ukegbu, P. O. (2017). Not a ‘Straitjacket Affair’: Anthropometrically Derived Obesity Index Correlates of Elevated Blood Pressure among University Undergraduates. Medical Sciences, 5(2), 9. https://doi.org/10.3390/medsci5020009

Ganiyu, K., Kpokiri, E., & Omoshue, O. (2015). Prevalence of Undiagnosed Elevated Blood Pressure in Okparabe Community in Southern Nigeria. 1.

Guo, X., Zhang, X., Hu, J., Sun, Y., Zheng, L., Zou, L., Li, J., & Sun, Z. (2012). The prevalence and heterogeneity of prehypertension: A meta-analysis and meta-regression of published literature worldwide. Cardiovascular Journal of Africa, 23(1), 44–50. https://doi.org/10.5830/CVJA-2011-058

Guwatudde, D., Nankya-Mutyoba, J., Kalyesubula, R., Laurence, C., Adebamowo, C., Ajayi, I., Bajunirwe, F., Njelekela, M., Chiwanga, F. S., Reid, T., Volmink, J., Adami, H.-O., Holmes, M. D., & Dalal, S. (2015). The burden of hypertension in sub-Saharan Africa: A four-country cross sectional study. BMC Public Health, 15(1), 1211. https://doi.org/10.1186/s12889-015-2546-z

Huang, Y., Guo, P., Karmacharya, B. M., Seeruttun, S. R., Xu, D. R., & Hao, Y. (2019). Prevalence of hypertension and prehypertension in Nepal: A systematic review and meta-analysis. Global Health Research and Policy, 4(1), 11. https://doi.org/10.1186/s41256-019-0102-6

Humanitarian Data Exchange. (2020). Nigeria - Subnational Administrative Boundaries. In The Humanitarian Data Exchange. https://data.humdata.org/dataset/nga-administrative-boundaries

Ibuaku, C., Nwajei, A., & Queen, A. (2018). Anthropometric Assessment of Nutritional Status of Adults in a Non-Conflict Environment of the Niger-Delta Region of Nigeria. 46–49.

Isezuo, S. A., Sabir, A. A., Ohwovorilole, A. E., & Fasanmade, O. A. (2011). Prevalence, associated factors and relationship between prehypertension and hypertension: A study of two ethnic African populations in Northern Nigeria. Journal of Human Hypertension. https://doi.org/10.1038/jhh.2010.56

Jin, N., Li, G., Li, H., Chen, L., & Leng, B. (2013). [Incidence and risk factors of prehypertension among adults in mainland China: a meta-analysis]. Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University, 33(12), 1738–1743.

Joffres, M., Falaschetti, E., Gillespie, C., Robitaille, C., Loustalot, F., Poulter, N., McAlister, F. A., Johansen, H., Baclic, O., & Campbell, N. (2013). Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: A cross-sectional study. BMJ Open, 3(8), e003423. https://doi.org/10.1136/bmjopen-2013-003423

Kooffreh, M., & M.G, A. (2016). Differences in Blood Pressure Levels and Its Association with Obesity Indices among Traders in Watt Market Calabar, Cross River State Nigeria. Scholars Academic Journal of Biosciences, 4, 565–570. https://doi.org/10.21276/sajb.2016.4.7.3

Makusidi, M. A., Liman, H. M., Yakubu, A., Isah, M. D. A., Jega, R. M., Adamu, H., & Chijioke, A. (2013). Prevalence of Non-communicable Diseases and its Awareness among Inhabitants of Sokoto Metropolis: Outcome of a Screening Program for Hypertension, Obesity, Diabetes Mellitus and Overt proteinuria. Arab Journal of Nephrology and Transplantation, 6(3), 189–191. https://doi.org/10.4314/ajnt.v6i3

National High Blood Pressure Education Program. (2004). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute (US). http://www.ncbi.nlm.nih.gov/books/NBK9630/

NCD Risk Factor Collaboration (NCD-RisC). (2017). Worldwide trends in blood pressure from 1975 to 2015: A pooled analysis of 1479 population-based measurement studies with 19\(\cdot\)1 million participants. Lancet (London, England), 389(10064), 37–55. https://doi.org/10.1016/S0140-6736(16)31919-5

Nkechi, O. I. (2018). Prevalence and Predictors of Overweight, Obesity and Hypertension among Undergraduates of a Southern Nigerian University. Journal of Medical Science And Clinical Research, 6(12). https://doi.org/10.18535/jmscr/v6i12.01

Nwatu, C. B., Young, E. E., Okwara, C. C., Okoli, C. E., Obi, P. C., Anyim, O. B., Ubani, B. C., Okafor, C. I., & Oli, J. M. (2017). Concurrent Prediabetes and Prehypertension in a Rural Community in South East Nigeria. Journal of Advances in Medicine and Medical Research, 1–10. https://doi.org/10.9734/JAMMR/2017/34226

Nwazor, F. O. O., & Oputa, S. C. (2012). Blood Pressure Pattern Among Young People In South-Eastern Nigeria: A Cross-Sectional Survey. Ebonyi Medical Journal, 11(1-2), 77–83. https://doi.org/10.4314/ebomed.v11i1-2

Obiebi, I. P., & Aiwuyo, H. O. (2019). 2017 American College of Cardiology/American Heart Association Clinical Guideline-based Prevalence of Hypertension in a semi-urban community in Nigeria: Public Health Perspective. Revista Colombiana de Cardiología, 26(6), 346–353. https://doi.org/10.1016/j.rccar.2019.02.007

Obiorah, M. O., Ogbodo, E. C., Amah, U. K., Ezeugwunne, I. P., Analike, R. A., Onah, C. E., Okwara, J. E., Egbe, J. U., Oha, P. C., Ajulu, C. A., & Ugwu, M. (2017). PREVALENCE OF PREHYPERTENSION AND ASSESSMENT OF CARDIOVASCULAR FUNCTION AMONG PREHYPERTENSIVE UNDERGRADUATE STUDENTS IN NNEWI, ANAMBRA STATE, NIGERIA. https://www.semanticscholar.org/paper/PREVALENCE-OF-PREHYPERTENSION-AND-ASSESSMENT-OF-IN-Ajulu-Meludu/b27a9be3c926f0ad37b641b726895f22e9878bab

Odili, A. N., Chori, B. S., Danladi, B., Nwakile, P. C., Okoye, I. C., Abdullahi, U., Nwegbu, M. N., Zawaya, K., Essien, I., Sada, K., Ogedengbe, J. O., Aje, A., & Isiguzo, G. C. (n.d.). Prevalence, Awareness, Treatment and Control of Hypertension in Nigeria: Data from a Nationwide Survey 2017. Global Heart, 15(1), 47. https://doi.org/10.5334/gh.848

Odunaiya, N., Okoye, E., Adegoke, O., Ojoye, D., & Ooguntibeju, O. (2021). High Prevalence and Clustering Of Modifiable Cardiovascular Disease Risk Factors among Nurses in Nigeria: Implication for Translating Knowledge into Practice among Health Care Professionals. International Journal of Public Health, 5, 1–7.

Ofori, S. N., Fobil, J. N., & Odia, O. J. (2018). Household biomass fuel use, blood pressure and carotid intima media thickness; a cross sectional study of rural dwelling women in Southern Nigeria. Environmental Pollution, 242, 390–397. https://doi.org/10.1016/j.envpol.2018.06.102

Okafor, C. I., Fasanmade, O., Ofoegbu, E., & Ohwovoriole, A. E. (2011). Comparison of the performance of two measures of central adiposity among apparently healthy Nigerians using the receiver operating characteristic analysis. Indian Journal of Endocrinology and Metabolism, 15(4), 320–326. https://doi.org/10.4103/2230-8210.85588

Okafor, Chinyere. N., Young, Ekenechukwu. E., Nwobi, Emmanuel. A., & Ike, Samuel. O. (2014). CARDIOVASCULAR RISK FACTORS IN A POPULATION OF RURAL WOMEN IN SOUTH-EAST NIGERIA. African Journal of Medicine and Medical Sciences, 43(Suppl 1), 225–232. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679289/

Okpechi, I. G., Chukwuonye, I. I., Tiffin, N., Madukwe, O. O., Onyeonoro, U. U., Umeizudike, T. I., & Ogah, O. S. (2013). Blood Pressure Gradients and Cardiovascular Risk Factors in Urban and Rural Populations in Abia State South Eastern Nigeria Using the WHO STEPwise Approach. PLoS ONE, 8(9), e73403. https://doi.org/10.1371/journal.pone.0073403

Okubadejo, N. U., Ozoh, O. B., Ojo, O. O., Akinkugbe, A. O., Odeniyi, I. A., Adegoke, O., Bello, B. T., & Agabi, O. P. (2019). Prevalence of hypertension and blood pressure profile amongst urban-dwelling adults in Nigeria: A comparative analysis based on recent guideline recommendations. Clinical Hypertension, 25, 7. https://doi.org/10.1186/s40885-019-0112-1

Okwuonu. (n.d.). Awareness of blood pressure status, undiagnosed hypertension and proteinuria among adults in Umuahia, South-East Nigeria. Retrieved July 9, 2021, from https://www.smjonline.org/article.asp?issn=1118-8561;year=2016;volume=19;issue=2;spage=82;epage=88;aulast=Okwuonu;type=3

Okwuonu, C. G., Ngoka, S. C., Chimezie, O. J., Eze, T. H., Uwanurochi, K., & Mbanaso, A. U. (2015). Towards prevention of hypertension in Nigeria: A study of prehypertension and its associations among apparently healthy adults in Umuahia, South-East Nigeria. International Journal of Preventive Medicine, 6, 61. https://doi.org/10.4103/2008-7802.160968

Oladoyinbo, C. A., Ekerette, N. N., & Ogunubi, T. I. (2015). Obesity and Hypertension amongst Traders in Ijebu Ode, Nigeria. African Journal of Biomedical Research, 18(1), 23–27. https://doi.org/10.4314/ajbr.v18i1

Olaitan, O. O. (2020). Central Obesity and Stress- Predisposing Factors to Hypertension among Health Workers in Jos University Teaching Hospital, Plateau State, Nigeria. Current Research in Diabetes & Obesity Journal, 12(4). https://doi.org/10.19080/CRDOJ.2020.12.555845

Olamoyegun, M., Iwuala, S., Asaolu, S., & Oluyombo, R. (2016). Epidemiology and patterns of hypertension in semi-urban communities, south-western Nigeria. Cardiovascular Journal of Africa, 27(6), 356–360. https://doi.org/10.5830/CVJA-2016-037

Olatona, F. A., Onabanjo, O. O., Ugbaja, R. N., Nnoaham, K. E., & Adelekan, D. A. (2018). Dietary habits and metabolic risk factors for non-communicable diseases in a university undergraduate population. Journal of Health, Population and Nutrition, 37(1), 21. https://doi.org/10.1186/s41043-018-0152-2

Olawade, D., Afolalu, T., Wada, O., & Barka, I. (2020). Evaluations of Hypertension among Adult Residents of Tinda Rural Community, Nigeria. 6, 157–162.

Ononamadu Chimaobi James, Ezekwesili Chinwe Nonyelum, Onyeukwu Onyemaechi Faith, Umeoguaju Uchenna Francis, Ezeigwe Obiajulu Christian, & Ihegboro Godwin Okwudiri. (2017). Comparative analysis of anthropometric indices of obesity as correlates and potential predictors of risk for hypertension and prehypertension in a population in Nigeria. Cardiovascular Journal of Africa, 28(2), 92–99. https://doi.org/10.5830/CVJA-2016-061

Opreh, O. P., Olajubu, T. O., Akarakiri, K. J., Ligenza, V., Amos, J. T., Adeyeye, A. V., Oyelade, O. Z., & Oyewole, F. C. (2021). Prevalence and factors associated with hypertension among rural community dwellers in a local government area, South West Nigeria. African Health Sciences, 21(1), 75–81. https://doi.org/10.4314/ahs.v21i1.12

Program, N. H. B. P. E. (2004). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute (US). https://www.ncbi.nlm.nih.gov/books/NBK9630/

R Core Team. (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.r-project.org/

Rai̇mi̇, T., & Odusan, O. (2020). Association of hypertension with generalized obesity in rural south-western Nigeria. Journal of Surgery and Medicine, 4(3), 177–181. https://doi.org/10.28982/josam.593387

Shittu, R. O., Odeigah, L. O., Fakorede, K. O., Sikiru, B. A., Sule, A. G., Musah, Y., & Adeyemi, F. M. (2018). Prevalence and correlates of hypertension-outcome of a free medical screening in Oke-Ogun area of Oyo state, Nigeria, West Africa. Journal of the American Society of Hypertension: JASH, 12(4), 268–274. https://doi.org/10.1016/j.jash.2018.01.009

Suleiman, I. A., Amogu, E. O., & Ganiyu, K. A. (2013). Prevalence and control of hypertension in a Niger Delta semi urban community, Nigeria. Pharmacy Practice, 11(1), 24–29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780508/

Tagurum, Y. O., Okoh, O. E., Inalegwu, E., Ozoilo, J. U., Banwat, M. E., & Zoakah, A. I. (2015). Non-communicable diseases: Prevalence and Risk Factors among Adults in a Rural Community in Plateau State, Nigeria. http://irepos.unijos.edu.ng/jspui/handle/123456789/1083

Tripathy, J. P., Thakur, J. S., Jeet, G., Chawla, S., & Jain, S. (2017). Alarmingly high prevalence of hypertension and pre-hypertension in North India-results from a large cross-sectional STEPS survey. PLOS ONE, 12(12), e0188619. https://doi.org/10.1371/journal.pone.0188619

Udo, K. R., Ajayi, J. F. A., Kirk-Greene, A. H. M., & Falola, T. O. (2020). Nigeria. Encyclopedia Britannica. https://www.britannica.com/place/Nigeria

Umuerri, E. M., & Aiwuyo, H. O. (2020). Prevalence and correlates of prehypertension and hypertension among adults in Delta State, Nigeria: A cross-sectional community-based study. Ghana Medical Journal, 54(1), 48–57. https://doi.org/10.4314/gmj.v54i1.10

UNFPA - United Nations Population Fund. (2021). UNFPA - United Nations Population Fund. https://www.unfpa.org/

Uwah, A., Idongesit, N., & Uka, E. (2015). Prevalence of hypertension among adults attending Faith-based Centres in Abak Township, Akwa Ibom State, Nigeria. 3, 245–248.

Vasan, R. S., Larson, M. G., Leip, E. P., Kannel, W. B., & Levy, D. (2001). Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: A cohort study. Lancet (London, England), 358(9294), 1682–1686. https://doi.org/10.1016/S0140-6736(01)06710-1

Wada, O., Olawade, D., Afolalu, T., O, O., & G, A. (2020). Prevalence of Hypertension among Rural Adults and Availability of Management Services in Abimbola Community, Ayedaade Local Government Area, Osun State, Nigeria. Journal of Hypertension and Management, 6. https://doi.org/10.23937/2474-3690/1510046

Wokoma, F. S., & Alasia, D. D. (2011). Blood Pressure Pattern in Barako - A Rural Community in Rivers State, Nigeria. Nigerian Health Journal, 11(1), 8–13. https://www.ajol.info/index.php/nhj/article/view/90500

Wordu, G., & O.M, A. (2018). Dietary Pattern and Prevalence of High Blood Pressure among Adult Traders in Port Harcourt, Nigeria. Asian Journal of Medicine and Health, 11, 1–7. https://doi.org/10.9734/AJMAH/2018/37430